Thursday, April 9, 2009

CAPD vs. CCPD... Survival Similar


In the incredibly shrinking world of peritoneal dialysis for stage 5 CKD, there are two basic modalities: CAPD (continuous ambulatory peritoneal dialysis) and CCPD (continuous cycling peritoneal dialysis). I still encourage PD for a subsegement of my patients requiring renal replacement therapy. When an informed patient choose PD, the goal is almost invariably to start with CAPD and transition to CCPD (AKA: APD- Automated Perioteal Dialysis). The 'cycler' is more convenient and allows for good clearance with usually only one daytime exchange. There has been some suggestion in the literature that CCPD may even have a survival benefit. This was challenged and reviewed in a study published online by CJASN ahead of print yesterday, April 8, 2009.

Patients on APD or CAPD at 3 mo after start of dialysis were selected from a prospective multicenter cohort study in incident dialysis patients (NECOSAD). Overall mortality was studied with an intention-to-treat design; the event was death. Technique failure was studied with an as-treated design; the event was a switch of dialysis modality. Hazard ratios (HRs) were calculated with a follow-up of 5 yr. The HRs were adjusted for gender, age, primary kidney disease, comorbidity, residual GFR, urine production and plasma albumin at 3 mo after inclusion.

Results: Eighty-seven APD and 562 CAPD patients were included. In the intention-to-treat analysis 154 CAPD and 21 APD patients died. The crude HR for overall mortality was 0.98 (95% CI: 0.62–1.54), the adjusted HR was 1.09. In the as-treated analysis 238 CAPD and 34 APD patients switched therapy, whereas 91 CAPD and 7 APD patients died. The crude HR for technique failure was 0.92 (95% CI: 0.64–1.31) and did not change after adjustment.

Conclusions: No difference was found in overall mortality and technique failure for APD compared with CAPD in incident dialysis patients.

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